HomeMy WebLinkAboutAgreement A-24-232 Fourth Amendment to Agreement with UCSF.pdf Agreement No. 24-232
1 FOURTH AMENDMENT TO AGREEMENT
2 THIS FOURTH AMENDMENT TO AGREEMENT (hereinafter "Amendment") is made and
3 entered into this 21st day of May , 2024, by and between COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, Fresno, California (hereinafter "COUNTY'), and The Regents of
5 the University of California, San Francisco, a public university, whose address is c/o Office of
6 Sponsored Research, 490 Illinois Street, 4th Floor, San Francisco, CA 94143 (hereinafter
7 "CONTRACTOR").
8 WITNESSETH:
9 WHEREAS, COUNTY and CONTRACTOR entered into Agreement number D-21-130, dated
10 April 21, 2021, pursuant to which CONTRACTOR agreed to provide on-call COVID-19 vaccination
11 administration teams, including all necessary staffing, to conduct on-call vaccination clinics that will
12 provide vaccinations and documentation (using the local immunization registry) to COUNTY residents;
13 and
14 WHEREAS, COUNTY and CONTRACTOR entered into a First Amendment number D-21-130-
15 1, dated October 8, 2021, to add the provision of monoclonal antibody therapy, flu vaccine
16 administration services, the addition of COVID-19 testing services, and increase the total
17 compensation to accommodate the provision of new and existing services through and including April
18 14, 2022; and
19 WHEREAS, COUNTY and CONTRACTOR entered into a Second Amendment number A-22-
20 378, dated August 23, 2022, to add the provisions to conduct screening, vaccination, and treatment of
21 communicable disease and increase the total compensation to accommodate the provision of new and
22 existing services through April 14, 2023; and
23 WHEREAS, COUNTY and CONTRACTOR entered into a Third Amendment number A-23-177,
24 dated April 11, 2023, to revise the scope of work to reduce the number of clinic days required
25 monthly, extend the agreement through May 31, 2024, and increase the total compensation to
26 accommodate the provision of existing services through May 31, 2024 (Agreement number D-21-130,
27 First Amendment number D-21-130-1, Second Amendment number A-22-378, and Third Amendment
28 number A-23-177 collectively, shall be referred to herein as "Agreement"); and
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1 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement to revise the
2 scope of work, extend the Agreement through May 31, 2026, and increase the total compensation to
3 accommodate the provision of existing services through May 31, 2026.
4 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
5 is hereby acknowledged, COUNTY and CONTRACTOR agree as follows:
6 1. That all references to "Third Revised Exhibit A" in existing COUNTY Agreement number
7 A-23-177 shall be changed to read, "Fourth Revised Exhibit A", attached hereto and incorporated
8 herein by reference.
9 2. That Section 3 of the Agreement, located on page 2, lines 7 through 12, is deleted in its
10 entirety and replaced with the following:
11 "The term of this Agreement shall be from April 15, 2021 through and including May 31,
12 2026."
13 3. That Section 5 of the Agreement, located on page 3, lines 8 through 19, is deleted in its
14 entirety and replaced with the following:
15 "COMPENSATION/INVOICING: COUNTY agrees to pay CONTRACTOR and
16 CONTRACTOR agrees to receive compensation for actual costs as identified in Third Revised Exhibit
17 B, attached hereto and incorporated herein by reference. CONTRACTOR shall submit monthly
18 invoices to the County of Fresno, Department of Public Health, 611 Floor, P.O. Box 11867, Fresno, CA
19 93775, Attention: Business Office or dphboap(a)-fresnocountyca.gov. Invoices shall be accompanied by
20 supporting cost documentation such as payroll records, equipment/supply invoices, lease payment,
21 payment records for marketing/education/outreach costs, utility/janitorial payment, mileage records if
22 applicable.
23 In no event shall services performed under this Agreement be in excess of Thirteen
24 Million Eight Hundred Five Thousand Forty-Six and 67/100 Dollars ($13,805,046.67) during the term of
25 this Agreement. It is understood that all expenses incidental to CONTRACTOR'S performance of
26 services under this Agreement shall be borne by CONTRACTOR. Invoice terms shall be a Net forty-
27 five (45) days from date of receipt of invoice by COUNTY."
28 COUNTY and CONTRACTOR agree that this Amendment is sufficient to amend the
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1 Agreement and, that upon execution of this Amendment, the Agreement and this Amendment together
2 shall be considered the Agreement.
3 The parties agree that this Amendment may be executed by electronic signature as provided in
4 this section. An "electronic signature" means any symbol or process intended by an individual signing
5 this Amendment to represent their signature, including but not limited to (1) a digital signature; (2) a
6 faxed version of an original handwritten signature; or (3) an electronically scanned and transmitted (for
7 example by PDF document) of a handwritten signature. Each electronic signature affixed or attached
8 to this Amendment (1) is deemed equivalent to a valid original handwritten signature of the person
9 signing this Amendment for all purposes, including but not limited to evidentiary proof in any
10 administrative or judicial proceeding, and (2) has the same force and effect as the valid original
11 handwritten signature of that person. The provisions of this section satisfy the requirements of Civil
12 Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
13 Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital signature represents that it
14 has undertaken and satisfied the requirements of Government Code section 16.5, subdivision (a),
15 paragraphs (1) through (5), and agrees that each other party may rely upon that representation. This
16 Amendment is not conditioned upon the parties conducting the transactions under it by electronic
17 means and either party may sign this Amendment with an original handwritten signature.
18 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
19 covenants, conditions and promises contained in the Agreement and not amended herein shall remain
20 in full force and effect.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Fourth Amendment to Agreement
2 as of the day and year first hereinabove written.
3
4 CONTRACTOR COUNTY OFFRESNO
The Regents of the University of
5 California, San Francisco
6
7 (Authorized Signa hire) Nathan Magsig, Chairman of the Board
of Supervisors of the County of Fresno
8 Catherine La garde, Contract Officer
Print Name & Title
9
10
11 Ran Erapqisco CA 04143
Mailing Address ATTEST:
12 Bernice E. Seidel
Clerk of the Board of Supervisors
13 County of Fresno, State of California
14
15
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17
By:
18 Deputy
FOR ACCOUNTING USE ONLY:
19
20 Fund: 0001
21 Subclass: 10000
22 ORG: 56201657, 56201018,
23 56201019
24 Account: 7295
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Fourth Revised Exhibit A
SCOPE OF WORK
The County of Fresno (County) Department of Public Health (DPH) is in need of temporary vendors to
provide on-call COVID vaccine, COVID testing, flu vaccine, and COVID-19 Therapy administration
teams,while also conducting screening,vaccination, and treatment of communicable diseases,
available for vaccination events. Licensed and unlicensed medical staff(Registered Nurses, Licensed
Vocational Nurses and Medical Assistants or Certified Nursing Assistants with valid licensure and/or
certification in the State of California) and clerical staff will be needed to conduct on-call vaccination
clinics that will provide vaccination and documentation through the appropriate State system(e.g. MY
Turn or Interface from allowed electronic medical record)to County residents. Clinics will be held
through employers or through community medical clinic/vaccination events that may be open to the
general public.
The vendor will work with County staff to determine the size, date and time of the clinic request. Lead
time to clinic scheduling will be 5 days—4 weeks. The County anticipates up to 20 clinics per month,
providing services to up to 125 patients per clinic. Clinic times will vary as follows:
• Any day of the week, including weekends and evenings.
• Clinic hours will vary from 3 —8 hours depending on size of event.
• Events may be held inside, outside or as a drive thru.
• Events may be located anywhere within Fresno County.
• Patients served will be dependent on which vaccine is being administered at the event. The Pfizer
vaccine is authorized for use in individuals 16 years of age and older. The Moderna and Janssen
vaccines are authorized for use in individuals 18 years of age and older. The COVID-19
Therapy is authorized for use in individuals over 12 years of age and older with mild-to-
moderate COVID-19 who meet criteria under the FDA's Emergency Use Authorization.
EUAs issued for each vaccine:
o Pfizer EUA: https://www.fda.gov/media/144412/download
o Moderna EUA: https://www.fda.gov/media/144637/download.
o Janssen EUA: Janssen COVID-19 Vaccine EUA Fact Sheet for Recipients and Caregivers
fda. ov
o Other vaccine requirements may vary. Vendor will be required to adhere to EUA for
specific vaccines as additional vaccines are approved by the Food and Drug
Administration (FDA).
• Vendor will be required to work with the venue host to determine if the vendor will need to
provide tables, chairs,popup tents, etc.
• At County's request, vendor may be required to conduct a similar event at the same venue in
order to administer required second doses of vaccine. Arrangements for both events shall be
made at the same time. Timing of the second event will depend on the recommended second
dose frequency: Pfizer is currently 21 days and Moderna is one month(see respective EUAs
linked above and CDC clinical considerations linked here: https://www.cdc.gov/vaccines/covid-
Page 1 of 5
Fourth Revised Exhibit A
19/info-by-product/clinical-considerations.html). Janssen vaccine is one dose only. Vendor
should always check for CDC and/or vaccine manufacturer updates to these requirements prior
to each event.
• When applicable, the requirement to conduct a second, similar event, and its timing, are subject
to change depending on vaccine availability at the time of the second event and changes in
recommended second dose administration timing.
• Any extra ancillary supplies not included with vaccine shipment must be supplied by vendor.
• The County prefers that the vaccine and ancillary supplies be shipped directly to the vendor
rather than be held by the County prior to the clinic. This will be dependent on the vendor's
ability to maintain vaccine at the appropriate temperatures (see Cold Storage Capacity, below)
and the size of the event.
The County will provide the following:
• Venue and direct payment to venue for any rental costs.
• Clinic date, time, location and venue contact information.
• Vaccine and ancillary supplies as provided for by CDPH. Depending on vendor's cold chain
capabilities and registered Provider status, vaccine and ancillary supplies may be shipped
directly to vendor or picked up at the Department of Public Health.
• For Pfizer, Moderna, Janssen, flu and potentially other vaccines, as well as Monoclonal
Antibody Therapy, we expect the following ancillary supplies to be provided with each 100
vaccine doses.
0 105 needles
0 105 syringes
0 210 alcohol prep pads
0 1 needle information card
0 100 vaccination cards
0 2 disposable face shields
0 4 surgical masks
The vendor will be responsible for the following:
• County prefers vendors to enroll as a Provider in the federal COVID-19 Vaccination Program,
utilizing the California Department of Public Health's (CDPH) COVIDReadi portal and agree
and adhere to all requirements specified in the Provider agreement. If provider is not currently
an approved California COVID vaccine provider then provider must adhere to all COVID
vaccine handling and reporting requirements established by the State of California.
• Vendor shall administer the vaccine and enter all vaccinations into the appropriate State system
within 24 hours of administration.
• Vendor is to provide all office supplies, ancillary medical supplies not included with vaccine,
PPE, tables, chairs, tents, etc., when needed.
Page 2 of 5
Fourth Revised Exhibit A
• Vaccine will be transferred according to CDC or VFC recommendations, such as noted in the
CDC's Vaccine Storage and Handling Toolkit, linked here:
https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html
• Return unused/unopened vaccines to DPH the day of the event, or the day following, as directed
by DPH when scheduling each event(to be determined prior to each event.) However, with
County's permission, vendor may retain unused vaccine for use on the following clinic date
provided vendor has appropriate cold storage capacity and the vaccine will not have expired per
manufacturer guidelines.
• If vendor has vaccine that may expire before it can be used at an upcoming vendor event, vendor
will work with the County to ensure any surplus or short-dated doses are transferred to an
approved provider in a timely manner.
• Document and notify DPH of any wasted vaccine doses.
• Staff in charge of storage and handling, will complete the 7 EZIZ training modules at the
following website: https://eziz.org/eziz-training/
• Per federal regulations, vendor is required to provide the appropriate EUA document to all
vaccine recipients:
o Pfizer: hitps://www.fda.gov/media/144414/download
o Moderna: htt2s://www.fda.gov/media/144638/download
O Janssen: Janssen COVID-19 Vaccine EUA Fact Sheet for Recipients and Caregivers(fda.gov)
• COVID-19 vaccination providers are required to report the following adverse events after
COVID-19 vaccination, and other adverse events if later revised by CDC, to VAERS:
hgps://vaers.hhs. og v/reportevent.html or calling 1-800-822-7967.
• Vaccination administration errors, whether or not associated with an adverse event
• Severe COVID-19 illness (e.g., resulting in hospitalization)
• Serious adverse events (AE) regardless of causality. Serious AEs are defined as:
o Death
o A life-threatening AE
o Inpatient hospitalization or prolongation of existing hospitalization
o Persistent or significant incapacity or substantial disruption of the ability to
conduct normal life functions
o A congenital anomaly/birth defect
o Multisystem Inflammatory Syndrome
�ospitalization
Important medical events that may not result in death, be life-threatening, or require
may be considered serious when, based upon appropriate medical judgment,
they may jeopardize the patient and may require medical or surgical intervention to prevent
one of the outcomes listed above
• Also report any additional select adverse events and/or any revised safety reporting requirements
per FDA's conditions of authorized use of vaccine(s)throughout the duration of any COVID-19
Vaccine being authorized under an Emergency Use Authorization(EUA).
• Vendor must make provision for patients with a history of anaphylaxis (due to any cause)to
remain for observation for 30 minutes. For all other persons, observation period is 15 minutes.
• In the event of anaphylactic reaction, vendor must maintain appropriate emergency equipment at
the event to manage anaphylaxis resulting from vaccination. See CDC recommended equipment
Page 3 of 5
Fourth Revised Exhibit A
linked here: hiLtps://www.cdc.gov/vaceines/covid-I9/info-by-product/Tfizer/angphylaxis-
management.html. Equipment supply should be sufficient to manage multiple patients
experiencing anaphylaxis.
Cold Storage Survey(please check as appropriate):
We have an ultra-low temperature freezer(temperature capability is -80°C to -60°C/-112°F to -
76°F). Freezer make/model and cubic feet: SO-LOW MODEL U85-22 23.1 cubic ft- 3 units
purchased. American Biotech Supply—ABT 115V-2186 17cubit ft. —3 units purchased
We have freezer storage capability (-25°C to -15°C/-IYF to 5°F). Freezer make/model and cubic
feet: MCA Corporation MODEL HMCF7W4—7 Cubic Feet
We have refrigerator storage capability (2°C to 8°C/36°F-40°F). Refrigerator make/model and
cubic feet: American Biotech Supply PH-ABT-HC S 16G 16 cubic ft.
*Current calibration certification will be required for freezers/refrigerators.
❑ We will pick up and return the vaccine the same day to the County and will make arrangements
with County staff on pick up and drop off times.
We have qualified container and packout for transport and digital data logger for continuous
temperature monitoring during transport. We have purchased 6 transport containers for the
purpose of transporting vaccines.
❑ We do not have qualified container and packout for transport and digital data logger for
continuous monitoring during transport and will need to borrow from the Department of Public
Health.
Per the CDC, a"qualified container and packout" are defined as "A type of container and
supplies specifically designed for use when packing vaccines for transport. They are passive
containers that do not require a power source and are `qualified' through laboratory testing under
controlled conditions to ensure they achieve and maintain desired temperatures for a set amount
of time." (hM2s://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf)
An example a qualified container is linked here: https://www.vericormed.com/product/cooler-
cool-cube-08-vaccine-transport-cooler-at-refrigerated-temperatures-fresh-vaccine-vt-08/
Vendor shall submit invoices to:
County of Fresno Department of Public Health
1221 Fresno Street, 6th fl. (Business Office)
Fresno, CA 93721
DPHBOAPkfresnocoppt ca._ov
Page 4 of 5
Fourth Revised Exhibit A
KEY RESOURCES
• CDC's Storage and Handling Toolkit
• CDC's COVID-19 Vaccination Information Page
• Phase Guidance:
o CDC's Phase 1A Powerpoint
o Interim ACIP Guidance
o Early NASEM Phase Guidance
Page 5 of 5
Fourth Revised Exhibit B
FCDPH Extension Budget 10/15-4114
Peterson
FTE I Monthly I Annual cost 12yearcost
Person nel-Salary+Benefits
Med Director KB 0.2 $ 9,259 $ 111,104 $ 222,208
Assistant Med Director SD 0.2 $ 6,272 $ 75,264 $ 150,528
Physician coverage 0.1 $ 3,136 $ 37,632 $ 75,264
Clinical Lead 0.4 $ 5,191 $ 62,294 $ 124,589
LVN Nurse 0.2 $ 2,513 $ 30,161 $ 60,323
Midlevel Provider#1 0.5 $ 12,328 $ 147,936 $ 295,872
Midlevel Provider#2 0.5 $ 12,328 $ 147,936 $ 295,872
Admin Supervisor MK 0.5 $ 6,489 $ 77,868 $ 155,736
Comm Coordinator NT 0.25 $ 1,863 $ 22,351 $ 44,702
Operations Coordinator JS 0.4 $ 4,903 $ 58,834 $ 117,667
Assistant Research Coordinator MS 0.4 $ 2,980 $ 35,762 $ 71,523
Sr Social Worker 0.25 $ 3,245 $ 38,934 $ 77,868
Medical Assistant#1 1 $ 7,406 $ 88,870 $ 177,741
Medical Assistant#2 1 $ 7,406 $ 88,870 $ 177,741
Medical Assistant#3 1 $ 7,406 $ 88,870 $ 177,741
Medical Assistant#4 1 $ 7,406 $ 88,870 $ 177,741
Medical Assistant#5 1 $ 7,406 $ 88,870 $ 177,741
Medical Assistant#6 0.5 $ 3,703 $ 44,435 $ 88,870
Finance Analyst 0.1 $ 1,165 $ 13,978 $ 27,956
Total $ 112,403 $ 1,348,841 $ 2,697,683
Capital Investment
IT equipment $ 1,667 $ 20,000 $ 40,000
Lab equipment $ 417 $ 5,000 $ 10,000
Total $ 3,543 $ 25,000 $ 50,000
Page 1 of 2
Fourth Revised Exhibit 6
Supplies
Facility/Rent $ 5,667 $ 68,000 $ 136,000
Fleet Maintenance/Lease $ 2,000 $ 24,000 $ 48,000
Clinic Supplies $ 2,000 $ 24,000 $ 48,000
Insurance/Licenses $ 750 $ 9,000 $ 18,000
Marketing/communications $ 1,000 $ 12,000 $ 24,000
Shipping -testing $ 250 $ 3,000 $ 6,000
Connectivity& Internet $ 333 $ 4,000 $ 8,000
EMR license $ 1,667 $ 20,000 $ 40,000
Office Supplies $ 667 $ 8,000 $ 16,000
Fuel $ 250 $ 3,000 $ 6,000
Mileage $ 527 $ 6,322 $ 12,644
Total $ 15,110 $ 181,322 $ 362,644
UCSF Network Costs $ 833 $ 10,000 $ 20,000
GAEL $ 100 $ 1,200 $ 2,400
Total $ 933 $ 11,200 $ 22,400
Total Direct $ 138,425 $ 1,566,363 $ 3,132,727
Indirect 10% $ 13,843 $ 156,636 $ 313,273
Total $ 152,268 $ 1,723,000 $ 3,446,000
Expected unspent carryover $ 1,200,000
Additional dollars $ 2,246,000
Total allowable $ 3,446,000
Page 2 of 2